title: Lamivudine resistance leading to de novo hepatitis B infection in recipients of hepatitis B core antibody positive liver allografts.
abstract: Most studies have shown that lamivudine (LAM) prophylaxis is sufficient to prevent hepatitis B virus (HBV) transmission in recipients of hepatitis B core antibody positive (HBcAb(+) ) allografts. However, de novo hepatitis B (DNHB) is known to occur in this patient population. Herein, we report a case series of four liver transplant recipients who developed DNHB after receiving HBcAb(+) allografts due to acquisition of LAM resistance mutations, suggesting that LAM prophylaxis may be suboptimal. A retrospective chart review was performed of all adult liver transplants performed at Mount Sinai from 2001 to 2010. A total of 79 patients received HBcAb(+) allografts for non-hepatitis B-related liver disease. Of these 79 recipients, four patients developed DNHB and were found to have documented LAM resistance. With the increasing use of HBcAb(+) donor livers, we suspect that there will also be a growing number of cases of DNHB due to acquisition of LAM resistance. We suggest that other agents, such as entecavir or tenofovir, be considered for use as prophylaxis in this patient population to decrease this risk.
authors.affiliation: Division of Liver Diseases, Mount Sinai School of Medicine, New York, New York, USA; Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Leong
authors.forename: Patrick
authors.initials: P
authors.lastname: Coty
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Fiel
authors.forename: Charissa
authors.initials: C
authors.lastname: Chang
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.forename: Thomas
authors.initials: T
authors.lastname: Schiano
keywords: de novo hepatitis B; lamivudine; liver transplant; prophylaxis; resistance